| NPI | 1588699342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301083089) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6631) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-07-10 |