NPI | 1053572347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 72265) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
208D00000X General Practice (Licence: GA 72265) | |
208D00000X General Practice (Licence: VA 0101249751) | |
Enumeration Date | 2008-06-19 |
Last Update Date | 2014-07-18 |