NPI | 1215066246 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 1200) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 1200) |
Enumeration Date | 2007-03-05 |
Last Update Date | 2007-07-08 |