| NPI | 1740546837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301101053) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2021-12-01 |