| NPI | 1952781783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 199698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 29588) |
| Enumeration Date | 2015-06-07 |
| Last Update Date | 2025-03-17 |