| NPI | 1245525690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A50182) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A50182) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2011-06-14 |