| NPI | 1578820569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A145706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A145706) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2024-08-12 |