NPI | 1982052577 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME139287) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME139287) |
Enumeration Date | 2016-05-24 |
Last Update Date | 2020-10-08 |