NPI | 1013928985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL PA3622) |
Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: FL ACN296) |
261QC1500X Clinic/Center, Community Health (Licence: PR MD11514) | |
Enumeration Date | 2006-08-10 |
Last Update Date | 2011-06-10 |