NPI | 1780695098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME112982) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 033863) |
Enumeration Date | 2006-08-11 |
Last Update Date | 2022-11-10 |