NPI | 1417924309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301068296) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME91236) |
Enumeration Date | 2006-03-01 |
Last Update Date | 2021-10-16 |