| NPI | 1457845703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301504367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351036992) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-10-06 |