NPI | 1891866737 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.202789) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35079430) |
Enumeration Date | 2006-11-13 |
Last Update Date | 2012-10-31 |