NPI | 1609937069 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME100933) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0014206) |
Enumeration Date | 2006-12-12 |
Last Update Date | 2024-05-13 |