| NPI | 1720287386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301090856) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301090856) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2023-10-23 |