NPI | 1629008214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 15478R) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101057937) |
Enumeration Date | 2006-07-03 |
Last Update Date | 2007-10-31 |