| NPI | 1790704344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA a23815) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A23815) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2015-05-08 |