NPI | 1871029462 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16401) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS14790) |
Enumeration Date | 2017-05-03 |
Last Update Date | 2019-06-20 |