| NPI | 1962996900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A173494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216784) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2024-03-04 |