NPI | 1215513262 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-03052) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 100149) |
207Q00000X Family Medicine (Licence: FL ME163815) | |
Enumeration Date | 2021-03-21 |
Last Update Date | 2025-09-26 |