| NPI | 1932550910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 18006) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 510122827) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2022-03-21 |