| NPI | 1790938868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301092330) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301092330) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2021-03-26 |