| NPI | 1598743882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301117312) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 65037) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-10-08 |