| NPI | 1639104029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301046128) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-07-21 |