NPI | 1750618674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: VA 0101043292) |
Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: IA 17826) |
Enumeration Date | 2009-11-13 |
Last Update Date | 2009-11-13 |