NPI | 1659592202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 1330) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4556) |
Enumeration Date | 2007-05-01 |
Last Update Date | 2011-01-05 |