NPI | 1639394372 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A7766) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS645) |
Enumeration Date | 2007-04-16 |
Last Update Date | 2007-07-08 |