| NPI | 1306228473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 202201333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301107628) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2022-09-28 |