| NPI | 1932350899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 111007) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2023-11-28 |