| NPI | 1538173265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 50402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101014793) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-12-28 |