NPI | 1679068506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A174176) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL52609) |
Enumeration Date | 2018-06-23 |
Last Update Date | 2022-07-14 |