NPI | 1700438454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155907) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT218891) |
Enumeration Date | 2019-07-12 |
Last Update Date | 2023-01-12 |