NPI | 1780621755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A4859) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R2A51) |
Enumeration Date | 2006-05-31 |
Last Update Date | 2018-02-21 |