NPI | 1639229040 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 99-332) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 4269) |
Enumeration Date | 2007-01-11 |
Last Update Date | 2007-07-08 |