NPI | 1124146113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: WV 1206) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1206) |
Enumeration Date | 2007-03-27 |
Last Update Date | 2007-07-18 |