| NPI | 1770782807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 56883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090407) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2022-02-22 |