NPI | 1114078995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 4535) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 35579) |
207Q00000X Family Medicine (Licence: MI 5101013320) | |
Enumeration Date | 2007-01-16 |
Last Update Date | 2009-03-31 |