NPI | 1033107701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101035356) |
Additional Taxonomies | 174400000X Specialist (Licence: VA 0101035356) |
Enumeration Date | 2005-10-07 |
Last Update Date | 2016-11-09 |