| NPI | 1447871587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG199628) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2023-09-29 |