| NPI | 1427578293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301501466) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351031142) |
| 207Q00000X Family Medicine (Licence: MI 4301113184) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2021-06-09 |