| 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 |