NPI | 1578501656 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME119982) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301039658) |
Enumeration Date | 2006-06-02 |
Last Update Date | 2024-03-30 |