| NPI | 1538359229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G27440) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200400581) |
| Enumeration Date | 2007-07-28 |
| Last Update Date | 2007-07-28 |