NPI | 1205823861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101013937) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI MB013937) |
Enumeration Date | 2005-09-29 |
Last Update Date | 2016-03-03 |