| NPI | 1477946762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101021914) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2021-03-29 |