| NPI | 1497867477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A24547) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A24547) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-03-24 |