NPI | 1043241961 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 4628) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G46971) |
Enumeration Date | 2006-07-06 |
Last Update Date | 2011-08-12 |