| NPI | 1669432613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301081305) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301096299) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2022-08-08 |