| NPI | 1427461532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A140135) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA A140135) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2023-03-16 |