| NPI | 1982101762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: CA A163587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A163587) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2022-09-13 |