NPI | 1124233945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C181092) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 14407) |
Enumeration Date | 2007-05-14 |
Last Update Date | 2023-08-31 |