| NPI | 1528158250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A21331) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A21331) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-11-26 |