| NPI | 1851734099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 81805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301109170) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2022-09-21 |