NPI | 1457315038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 1971) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 37593) |
Enumeration Date | 2006-04-12 |
Last Update Date | 2012-01-25 |