NPI | 1184695207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 14705) |
Additional Taxonomies | 174400000X Specialist (Licence: PR 14705) |
Enumeration Date | 2006-01-27 |
Last Update Date | 2008-08-29 |