NPI | 1811992530 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C42420) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA C42420) |
Enumeration Date | 2005-06-17 |
Last Update Date | 2024-10-25 |