NPI | 1528597424 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A169709) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT212574) |
Enumeration Date | 2017-06-06 |
Last Update Date | 2022-07-21 |