NPI | 1508250804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A14985) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A14985) |
Enumeration Date | 2015-03-25 |
Last Update Date | 2023-07-06 |