| NPI | 1972884385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A43282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A43282) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA A43282) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2023-02-17 |