NPI | 1275517237 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 45303) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 49211) |
207Q00000X Family Medicine (Licence: CA A90426) | |
Enumeration Date | 2005-12-02 |
Last Update Date | 2008-12-02 |