| NPI | 1659359164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: MI 5101014149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101014149) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2022-02-26 |