| NPI | 1043214414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301098801) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 40601) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2023-01-27 |