NPI | 1013112580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME100083) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN9212) |
Enumeration Date | 2007-06-15 |
Last Update Date | 2019-02-01 |