| NPI | 1104236637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301104814) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI L216537) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2023-08-02 |