NPI | 1245210319 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 39737) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007007781) |
Enumeration Date | 2006-01-17 |
Last Update Date | 2013-07-15 |