| NPI | 1740809730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301508641) |
| Additional Taxonomies | 261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: MI 4301508641) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2023-12-01 |