| NPI | 1720605983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 100900-875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046915) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2023-10-26 |