NPI | 1033117296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-179) |
Additional Taxonomies | 208D00000X General Practice (Licence: ID O-179) |
Enumeration Date | 2005-07-12 |
Last Update Date | 2012-04-02 |