| NPI | 1811321748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A143413) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2024-12-18 |