| NPI | 1699910083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G60966) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC MMD.91514) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2026-01-27 |