NPI | 1356348015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-5119) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD15650) |
Enumeration Date | 2005-07-07 |
Last Update Date | 2012-09-27 |