NPI | 1487085841 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A13052) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A13052) |
Enumeration Date | 2013-12-10 |
Last Update Date | 2015-12-08 |