NPI | 1639495245 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107380) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME107380) |
208D00000X General Practice (Licence: FL ME107380) | |
Enumeration Date | 2010-04-08 |
Last Update Date | 2023-06-14 |