NPI | 1356667539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA PA20823) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20823) |
Enumeration Date | 2010-04-13 |
Last Update Date | 2011-02-11 |