NPI | 1962434241 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A89039) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A89039) |
Enumeration Date | 2006-07-07 |
Last Update Date | 2020-03-18 |