| NPI | 1750815817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301504363) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 67237) |
| Enumeration Date | 2017-04-16 |
| Last Update Date | 2021-09-27 |