NPI | 1700060092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-00567) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 16949) |
207Q00000X Family Medicine (Licence: VA 0101244562) | |
Enumeration Date | 2007-12-21 |
Last Update Date | 2011-12-06 |