NPI | 1083686315 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101231582) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 79262) |
Enumeration Date | 2006-02-02 |
Last Update Date | 2011-08-18 |