NPI | 1033370739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 60291304) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301092697) |
Enumeration Date | 2008-06-24 |
Last Update Date | 2012-10-23 |