| NPI | 1457917569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301507711) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME157390) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2022-09-29 |