| NPI | 1245694587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A158921) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 158921) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2021-09-20 |