| NPI | 1982804241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 243268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C130807) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2025-09-13 |