| NPI | 1063537454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G20059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G20069) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA G20059) | |
| 208600000X Surgery (Licence: CA G20059) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2025-09-11 |