NPI | 1104836022 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-02080) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME142535) |
207Q00000X Family Medicine (Licence: SC 18832) | |
Enumeration Date | 2006-08-09 |
Last Update Date | 2023-12-04 |