| NPI | 1750777066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101021949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO194421) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-11-04 |