NPI | 1104886928 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200800345) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02613) |
Enumeration Date | 2006-03-24 |
Last Update Date | 2018-01-25 |