NPI | 1700857729 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-4771) |
Additional Taxonomies | 174400000X Specialist (Licence: ID M4771) |
Enumeration Date | 2006-01-28 |
Last Update Date | 2012-05-31 |