| NPI | 1821436726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301110787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 191644) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2016-09-02 |