| NPI | 1982091385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A160353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD463158) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2022-05-11 |