NPI | 1265751267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110715) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN15063) |
Enumeration Date | 2010-05-31 |
Last Update Date | 2012-03-08 |