NPI | 1861707994 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A112720) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A112720) |
Enumeration Date | 2010-08-12 |
Last Update Date | 2024-02-23 |