NPI | 1700205424 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME149415) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD465714) |
Enumeration Date | 2014-04-09 |
Last Update Date | 2023-11-16 |