NPI | 1942284831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A66851) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60183294) |
Enumeration Date | 2005-12-03 |
Last Update Date | 2023-08-22 |