| NPI | 1972554301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G32307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 013802) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-03-07 |