NPI | 1972606929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0S6371) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 31994) |
Enumeration Date | 2006-09-06 |
Last Update Date | 2007-07-08 |