NPI | 1902891518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M8556) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041052) |
Enumeration Date | 2005-09-20 |
Last Update Date | 2010-01-11 |