NPI | 1558548826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS 006701E) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK AA1562) |
Enumeration Date | 2008-01-29 |
Last Update Date | 2009-07-08 |