NPI | 1477870210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA C159092) |
Additional Taxonomies | 208D00000X General Practice (Licence: LA MD.205087) |
Enumeration Date | 2010-05-03 |
Last Update Date | 2025-06-04 |