NPI | 1528114410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA A88510) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A88510) |
Enumeration Date | 2007-01-25 |
Last Update Date | 2021-11-12 |