| NPI | 1639306863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C166591) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 44040) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2020-09-08 |