NPI | 1124026992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150657) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301068650) |
Enumeration Date | 2005-07-14 |
Last Update Date | 2023-08-31 |