NPI | 1467515809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA a36372) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA Pa10741) |
Enumeration Date | 2006-12-18 |
Last Update Date | 2024-09-12 |