| NPI | 1841411709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA g33404) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G33404) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2009-12-14 |