NPI | 1235139437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A5509) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA E49730) |
Enumeration Date | 2005-07-28 |
Last Update Date | 2016-02-22 |