NPI | 1235216888 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME95369) |
Additional Taxonomies | 208600000X Surgery (Licence: FL ME95369) |
208D00000X General Practice (Licence: FL ME95369) | |
208600000X Surgery (Licence: OH 35072292) | |
Enumeration Date | 2006-11-01 |
Last Update Date | 2024-12-18 |