NPI | 1578561973 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122139) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A69968) |
Enumeration Date | 2005-07-08 |
Last Update Date | 2019-09-17 |