NPI | 1487829404 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 5101005130) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101005130) |
Enumeration Date | 2008-04-30 |
Last Update Date | 2008-04-30 |