NPI | 1932550910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 18006) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 510122827) |
Enumeration Date | 2016-06-30 |
Last Update Date | 2022-03-21 |