| NPI | 1134348485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-00430) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016178) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-08-01 |