| NPI | 1497283329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301502572) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301502572) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2023-09-27 |