| NPI | 1033407689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301099542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2014-0512) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2021-03-02 |