| NPI | 1285664391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101012776) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 48936-021) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-09-04 |