| NPI | 1982137261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 73939-21) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2024-04-08 |