| NPI | 1548356603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201100288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301079385) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-03-31 |