| NPI | 1962481929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C53165) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA C53165) |
| 207Q00000X Family Medicine (Licence: SC 21229) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2026-04-02 |