NPI | 1356572101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 8932A) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL0644) |
Enumeration Date | 2009-07-28 |
Last Update Date | 2015-06-08 |