NPI | 1245525690 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA A50182) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A50182) |
Enumeration Date | 2011-06-14 |
Last Update Date | 2011-06-14 |