NPI | 1578654109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G22621) |
Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: CA G22621) |
Enumeration Date | 2006-09-27 |
Last Update Date | 2023-09-06 |