| NPI | 1518520469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301512807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0101526) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-08-21 |