| NPI | 1831619980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73737-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351040187) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-07-21 |