NPI | 1528031556 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 103430) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-30613) |
Enumeration Date | 2006-02-09 |
Last Update Date | 2007-07-08 |