| NPI | 1679917280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A22510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 17139) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2026-06-01 |