| NPI | 1043668650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301117381) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301109373) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2022-06-27 |