| NPI | 1184657231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G36952) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA G 36952) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2014-07-15 |