| NPI | 1811992530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C42420) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA C42420) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2024-12-02 |