NPI | 1306132915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122796) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116023233) |
Enumeration Date | 2011-06-22 |
Last Update Date | 2020-03-03 |