NPI | 1831182591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A9700) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 056210) |
Enumeration Date | 2005-08-29 |
Last Update Date | 2024-05-07 |