NPI | 1346405362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 55667-20) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R8400) |
Enumeration Date | 2008-07-21 |
Last Update Date | 2016-09-15 |