NPI | 1285956987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 010369) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 2409) |
Enumeration Date | 2010-02-22 |
Last Update Date | 2010-02-22 |