NPI | 1568923712 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME174086) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 323286) |
Enumeration Date | 2019-03-29 |
Last Update Date | 2025-07-08 |