| NPI | 1003816141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G778170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G77817) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2025-04-23 |