| NPI | 1205884715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI gm012991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 12467A) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-07-22 |