NPI | 1104071224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR 150495) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TN MD37095) |
Enumeration Date | 2008-11-18 |
Last Update Date | 2010-07-06 |