NPI | 1962996900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A173494) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216784) |
Enumeration Date | 2018-06-21 |
Last Update Date | 2024-03-04 |