NPI | 1013118157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0011459) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 77229) |
261QU0200X Clinic/Center, Urgent Care | |
Enumeration Date | 2007-05-29 |
Last Update Date | 2013-09-27 |