NPI | 1265418644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 16908) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 1314) |
Enumeration Date | 2005-12-19 |
Last Update Date | 2007-12-04 |