NPI | 1083909600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20a11760) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os11205) |
Enumeration Date | 2011-06-10 |
Last Update Date | 2012-06-15 |