NPI | 1770514390 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 49097) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A73320) |
207Q00000X Family Medicine (Licence: SD 9701) | |
Enumeration Date | 2006-07-05 |
Last Update Date | 2016-06-23 |