| NPI | 1336633742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301502149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351041142) |
| 207Q00000X Family Medicine (Licence: MI 4301115644) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2022-04-13 |