| NPI | 1770848194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 66946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301107370) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2023-10-13 |