NPI | 1861456592 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131235) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01055241A) |
Enumeration Date | 2006-04-12 |
Last Update Date | 2022-07-21 |