NPI | 1023090289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101048298) |
Additional Taxonomies | 174400000X Specialist (Licence: VA 0101048298) |
Enumeration Date | 2005-11-15 |
Last Update Date | 2012-01-03 |