NPI | 1609886100 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 34858) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 38261) |
Enumeration Date | 2006-08-08 |
Last Update Date | 2015-11-06 |