NPI | 1679681555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 27708) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 29974) |
Enumeration Date | 2006-08-29 |
Last Update Date | 2011-11-22 |