NPI | 1609822055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 0904) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 30526) |
Enumeration Date | 2006-05-26 |
Last Update Date | 2011-11-25 |