| NPI | 1417924309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301068296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME91236) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2021-10-16 |