| NPI | 1275658536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME57718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301051610) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-07-25 |