| NPI | 1417216854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101019776) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2015-01478) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2019-09-12 |