| NPI | 1730531849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351037367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301110285) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2019-01-17 |