| NPI | 1467896506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 60782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301102329) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2020-06-24 |