| NPI | 1295902021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 076487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301091907) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2022-01-10 |