NPI | 1962489195 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME47243) |
Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL ME47243) |
Enumeration Date | 2005-12-29 |
Last Update Date | 2023-08-30 |