NPI | 1366416232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107676) |
Additional Taxonomies | 174400000X Specialist (Licence: PA MD425999) |
Enumeration Date | 2006-02-15 |
Last Update Date | 2024-04-16 |