| NPI | 1215467055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 7221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101023350) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2021-06-25 |