| NPI | 1952357741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A5373) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 3569) |
| 208D00000X General Practice (Licence: NV 767) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2024-01-04 |