| NPI | 1952456584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A89458) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 11777) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |