NPI | 1235120569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301044600) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 56924) |
Enumeration Date | 2005-11-04 |
Last Update Date | 2007-07-08 |