| NPI | 1780638528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A69991) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A69991) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2019-04-26 |