NPI | 1417963026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 056212) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200101250) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2009-05-13 |