| NPI | 1265664866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G27300) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA GFE27300) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2021-12-09 |