| NPI | 1447434154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A10213) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101017112) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2023-10-02 |