NPI | 1033131883 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME145947) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 210572) |
207Q00000X Family Medicine (Licence: MA 274001) | |
Enumeration Date | 2006-07-24 |
Last Update Date | 2025-01-03 |