NPI | 1730104779 |
---|---|
Former Name | JOHN B BAXLEY |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 16872) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 8997) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2010-10-27 |