| NPI | 1760408470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A35852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A35852) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2008-11-05 |