NPI | 1235195017 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60404371) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 31705) |
Enumeration Date | 2006-04-21 |
Last Update Date | 2015-03-26 |