| NPI | 1194980367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 47542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301095075) |
| Enumeration Date | 2008-07-27 |
| Last Update Date | 2021-01-26 |