| NPI | 1417338245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301500953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 281255) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-04-12 |