| NPI | 1154856680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA a156866) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A156866) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2021-12-28 |