| NPI | 1750875712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301114806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315091721) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-12-11 |