| NPI | 1881009413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82586) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301111886) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-09-01 |