| NPI | 1982674438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C136227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-15199) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-04-24 |