NPI | 1053804997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL TRN27047) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME143495) |
Enumeration Date | 2018-06-13 |
Last Update Date | 2024-12-16 |