| NPI | 1952668063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C159495) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 071543) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2021-04-16 |