NPI | 1366533481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00047202) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 48146) |
Enumeration Date | 2006-09-27 |
Last Update Date | 2023-03-07 |