| NPI | 1942584545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD171986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A118063) |
| Enumeration Date | 2011-10-01 |
| Last Update Date | 2021-12-08 |