NPI | 1417033291 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G59842) |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA G59842) |
207QA0505X Family Medicine, Adult Medicine (Licence: CA G59542) | |
207QG0300X Family Medicine, Geriatric Medicine (Licence: CA G59842) | |
207QS0010X Family Medicine, Sports Medicine (Licence: CA G59842) | |
Enumeration Date | 2006-10-27 |
Last Update Date | 2019-10-04 |