NPI | 1861573149 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA G56249) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA g56249) |
207QB0002X Family Medicine, Bariatric Medicine (Licence: CA G56249) | |
207KA0200X Allergy & Immunology, Allergy (Licence: CA G56249) | |
Enumeration Date | 2006-10-17 |
Last Update Date | 2015-12-13 |