| NPI | 1609316538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A44892) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI 16317) |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2017-02-25 |