| NPI | 1386696599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34010538) |
| 207Q00000X Family Medicine (Licence: MI 5101010925) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-03-17 |