NPI | 1265731392 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 22535) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME T1101) |
207Q00000X Family Medicine (Licence: CT 55916) | |
Enumeration Date | 2011-03-15 |
Last Update Date | 2025-04-11 |