| NPI | 1053843540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A18038) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 18038) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2020-07-21 |