NPI | 1144239054 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME140656) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420009208) |
Enumeration Date | 2006-08-07 |
Last Update Date | 2019-07-01 |