| NPI | 1457490567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A38915) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A 38915) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2025-10-30 |