NPI | 1811931751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME75224) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 044174) |
Enumeration Date | 2006-06-15 |
Last Update Date | 2007-07-08 |