NPI | 1245203256 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 13366) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 040983) |
Enumeration Date | 2006-02-09 |
Last Update Date | 2012-08-08 |