| NPI | 1841850997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301504906) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-09-07 |