| NPI | 1437313970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110479) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301093030) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2020-08-25 |