| NPI | 1578762712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA a99988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A99988) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2023-03-23 |