| NPI | 1477828861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A12921) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA 20A12921) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2023-09-20 |