NPI | 1477993533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A161545) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 285160) |
Enumeration Date | 2013-07-03 |
Last Update Date | 2023-01-13 |