| NPI | 1225177215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A99282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2004-0264) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2010-04-02 |