NPI | 1194709238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113171) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 26405) |
207Q00000X Family Medicine (Licence: AZ 30620) | |
Enumeration Date | 2005-12-02 |
Last Update Date | 2013-03-07 |