| NPI | 1083879084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A115809) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A115809) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2019-12-31 |