NPI | 1154388759 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146890) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00049360) |
Enumeration Date | 2006-04-27 |
Last Update Date | 2024-12-17 |