NPI | 1457387482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A4941) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 1207) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2019-11-15 |