NPI | 1457410110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60644369) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G42527) |
Enumeration Date | 2006-12-08 |
Last Update Date | 2022-10-14 |