NPI | 1780675876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME127949) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 225376) |
207Q00000X Family Medicine (Licence: CA A066341) | |
207Q00000X Family Medicine (Licence: NY 277732) | |
Enumeration Date | 2005-10-29 |
Last Update Date | 2024-02-20 |