NPI | 1750873816 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 290810) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT215340) |
207Q00000X Family Medicine (Licence: PA MD475400) | |
Enumeration Date | 2018-06-05 |
Last Update Date | 2023-07-09 |