NPI | 1558319293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA G45595) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 9971) |
Enumeration Date | 2006-05-05 |
Last Update Date | 2024-09-16 |