NPI | 1467432484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 39999) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 19638) |
Enumeration Date | 2006-01-17 |
Last Update Date | 2008-09-02 |