| NPI | 1902240344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A136382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A136382) |
| Enumeration Date | 2013-04-27 |
| Last Update Date | 2021-10-28 |