| NPI | 1891724993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A88734) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A88734) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2025-07-09 |