NPI | 1134128523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS013096) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA PA 05013096) |
Enumeration Date | 2005-07-18 |
Last Update Date | 2010-03-19 |