NPI | 1801858105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137329) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33907) |
Enumeration Date | 2006-04-04 |
Last Update Date | 2018-10-11 |