| NPI | 1013153063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301096745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 19773UO1) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2025-05-06 |