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 |