| NPI | 1841654142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301501715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 297480) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2020-08-04 |