| NPI | 1558698829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A109900) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: CA A109900) |
| Enumeration Date | 2009-11-07 |
| Last Update Date | 2023-03-08 |