NPI | 1649269184 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD23696) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420009507) |
Enumeration Date | 2005-10-18 |
Last Update Date | 2020-09-30 |