NPI | 1831110519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 10604) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A69293) |
Enumeration Date | 2006-07-21 |
Last Update Date | 2012-05-04 |