NPI | 1255562195 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 122567) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 13915) |
207Q00000X Family Medicine (Licence: NV 13915) | |
Enumeration Date | 2009-07-27 |
Last Update Date | 2021-10-27 |