NPI | 1982601159 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 110249) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 12292) |
Enumeration Date | 2005-07-03 |
Last Update Date | 2024-11-11 |