| NPI | 1225075898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 058544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301074613) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-10-01 |