NPI | 1982636288 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G34033) |
Additional Taxonomies | 174400000X Specialist (Licence: CA G34033) |
261QU0200X Clinic/Center, Urgent Care | |
Enumeration Date | 2006-07-07 |
Last Update Date | 2024-09-06 |