| NPI | 1376548107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301511075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 1919) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2024-04-16 |