NPI | 1457592552 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 076391) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 39928) |
Enumeration Date | 2009-03-19 |
Last Update Date | 2016-07-27 |