NPI | 1396073037 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012025722) |
Additional Taxonomies | 208600000X Surgery (Licence: OH 57.017025) |
207Q00000X Family Medicine (Licence: MO 2010019777) | |
Enumeration Date | 2009-11-18 |
Last Update Date | 2013-08-20 |