| NPI | 1801959481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101013376) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-05-27 |