| NPI | 1487085841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A13052) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A13052) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2015-12-08 |