NPI | 1235220773 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 48011) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016019) |
207Q00000X Family Medicine (Licence: NC 2007-00332) | |
Enumeration Date | 2006-09-28 |
Last Update Date | 2014-07-21 |