| NPI | 1629297163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G80659) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G 80659) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2015-02-03 |