| NPI | 1134320237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 38543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 38543) |
| 207Q00000X Family Medicine (Licence: CA G24813) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2019-02-27 |