NPI | 1609862358 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA c178170) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD424475) |
Enumeration Date | 2005-09-27 |
Last Update Date | 2023-03-07 |