| NPI | 1841485992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301080916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 98-214) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2023-03-07 |