NPI | 1295723112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2009-0562) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD0028340) |
207Q00000X Family Medicine (Licence: MT 11635) | |
Enumeration Date | 2005-10-13 |
Last Update Date | 2009-09-04 |