| NPI | 1871502211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 46510) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A46510) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-03-04 |