| NPI | 1154391498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A68510) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A68510) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2013-11-27 |