| NPI | 1609215458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301108846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301108846) |
| 207L00000X Anesthesiology (Licence: OH 57. 021966) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2024-02-01 |