NPI | 1801234570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125754) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN19107) |
Enumeration Date | 2013-06-04 |
Last Update Date | 2024-11-18 |