| NPI | 1912010844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G53276) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G53276) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |