| NPI | 1063569341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60556066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301095325) |
| 207Q00000X Family Medicine (Licence: IA 37955) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2021-04-08 |