NPI | 1063410579 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME143542) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2003002302) |
Enumeration Date | 2005-07-08 |
Last Update Date | 2024-01-03 |