| NPI | 1861573149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G56249) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA g56249) |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: CA G56249) | |
| 207KA0200X Allergy & Immunology, Allergy (Licence: CA G56249) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-12-13 |