| NPI | 1417136128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A99070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A99070) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2013-06-12 |