| NPI | 1952476848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A75792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD073274L) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2026-06-18 |