| NPI | 1710337381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 146579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301109401) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2019-11-12 |