| NPI | 1275598765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A43752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A43752) |
| 208000000X Pediatrics (Licence: CA A43752) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2022-06-23 |