| NPI | 1043301195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G69466) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD d0047320) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-03-07 |