NPI | 1730269853 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 22404) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 2890A) |
Enumeration Date | 2006-10-16 |
Last Update Date | 2018-01-12 |