| NPI | 1821610114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C32845) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C32845) |
| Enumeration Date | 2020-05-10 |
| Last Update Date | 2020-05-10 |