NPI | 1417205618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA 00017394) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WA 00017394) |
Enumeration Date | 2012-08-17 |
Last Update Date | 2012-08-17 |