NPI | 1366458317 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G88694) |
Additional Taxonomies | 174400000X Specialist (Licence: HI 5149) |
174400000X Specialist (Licence: CA G88694) | |
Enumeration Date | 2006-07-31 |
Last Update Date | 2018-03-17 |