| NPI | 1194287037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301517817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 82450) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2026-07-08 |