| NPI | 1801993092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD21965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301039477) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-09-22 |