NPI | 1437125473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101012723) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 50712) |
Enumeration Date | 2006-02-28 |
Last Update Date | 2013-03-11 |