| NPI | 1447666482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 68182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 67281) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2022-11-28 |