| NPI | 1427161173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G75747) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX P3488) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2013-10-16 |