| NPI | 1588706832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A81236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A81236) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2008-12-18 |