| NPI | 1710291570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A111081) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A111081) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2025-04-14 |