NPI | 1194762427 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME82266) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME82266) |
Enumeration Date | 2006-06-02 |
Last Update Date | 2013-04-01 |