NPI | 1083945265 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: HI 305R00000X) |
Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: HI 302F00000X) |
Enumeration Date | 2010-01-27 |
Last Update Date | 2010-01-27 |