NPI | 1720177678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50997) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301073008) |
Enumeration Date | 2006-10-11 |
Last Update Date | 2013-08-08 |