NPI | 1962481713 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 48225) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G459940) |
Enumeration Date | 2006-01-11 |
Last Update Date | 2012-03-01 |