| NPI | 1164412466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101011159) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2020-01-20 |