NPI | 1003811969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A102920) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2005-0303) |
Enumeration Date | 2005-06-16 |
Last Update Date | 2021-11-04 |