NPI | 1669885885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A149859) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT207310) |
Enumeration Date | 2014-06-05 |
Last Update Date | 2022-07-21 |