NPI | 1154310761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME97222) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI GP041179) |
Enumeration Date | 2005-10-17 |
Last Update Date | 2010-10-29 |