| NPI | 1295794725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G75907) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G075907) |
| 208D00000X General Practice (Licence: CA G75907) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2012-01-20 |