NPI | 1205834306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G42705) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 4413) |
Enumeration Date | 2005-07-12 |
Last Update Date | 2014-07-16 |