NPI | 1578625364 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A20149) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A20149) |
207R00000X Internal Medicine (Licence: CA A20149) | |
207V00000X Obstetrics & Gynecology (Licence: CA A20149) | |
208000000X Pediatrics (Licence: CA A20149) | |
Enumeration Date | 2006-12-15 |
Last Update Date | 2017-10-16 |