| NPI | 1508056128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A84802) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A84802) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2017-01-03 |