NPI | 1710239223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C55546) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18238) |
Enumeration Date | 2012-10-08 |
Last Update Date | 2020-04-16 |