NPI | 1073993135 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129981) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 21810) |
Enumeration Date | 2015-06-04 |
Last Update Date | 2018-07-13 |