| NPI | 1700467834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A24537) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 2773) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2026-06-23 |