NPI | 1235130337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA GFE69629) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41758-020) |
Enumeration Date | 2005-08-10 |
Last Update Date | 2007-07-08 |