NPI | 1730476151 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A134692) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 276094) |
Enumeration Date | 2011-07-06 |
Last Update Date | 2024-07-02 |