NPI | 1659460764 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME45888) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 45888) |
Enumeration Date | 2006-10-12 |
Last Update Date | 2014-05-06 |