NPI | 1467806448 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142526) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A151611) |
Enumeration Date | 2016-04-16 |
Last Update Date | 2025-03-13 |