| NPI | 1033341821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101018497) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS11701) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2025-09-29 |