NPI | 1205948247 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R8G07) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E4127) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2012-09-11 |