| NPI | 1508250804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A14985) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A14985) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2023-07-06 |