NPI | 1003894007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60175109) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A5460) |
Enumeration Date | 2006-01-09 |
Last Update Date | 2018-12-13 |