NPI | 1407810179 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-1382-06) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM t-252) |
Enumeration Date | 2006-04-12 |
Last Update Date | 2013-02-14 |