| NPI | 1720402977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA GFE68043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 62712) |
| Enumeration Date | 2014-02-08 |
| Last Update Date | 2021-04-30 |