| NPI | 1134103583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301047125) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301407125) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2020-11-10 |