NPI | 1982676052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 152641) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 12717) |
Enumeration Date | 2006-02-03 |
Last Update Date | 2016-04-06 |