NPI | 1619196284 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: WV 19054) |
Additional Taxonomies | 208D00000X General Practice (Licence: OH 35080175) |
208D00000X General Practice (Licence: KY 35931) | |
Enumeration Date | 2007-04-24 |
Last Update Date | 2007-07-08 |