| NPI | 1407881741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA g59768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G59768) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-04-12 |