| NPI | 1952041808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 24150) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 9536) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-10-10 |