| NPI | 1558856518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 89447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301115546) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2021-10-13 |