| NPI | 1942738554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A166128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT213622) |
| 207Q00000X Family Medicine (Licence: PA MD468259) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2021-12-20 |