| NPI | 1376771865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 074339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301094801) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2021-02-15 |