| NPI | 1053456970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A6032) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A6032) |
| 207R00000X Internal Medicine (Licence: CA 20A6032) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-02-26 |