| NPI | 1992267603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A195295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 314418) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-08-06 |