NPI | 1447246574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00027416) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M6675) |
Enumeration Date | 2005-09-23 |
Last Update Date | 2012-04-13 |