NPI | 1699017475 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A171338) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2015-0787) |
Enumeration Date | 2013-03-20 |
Last Update Date | 2021-12-20 |