NPI | 1194862433 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 15942) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 20764) |
207Q00000X Family Medicine (Licence: MN 22229) | |
Enumeration Date | 2007-01-30 |
Last Update Date | 2009-04-02 |