| NPI | 1467749929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 38595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301099284) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2021-02-03 |