| NPI | 1881605152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 65957) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI RD087681) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2019-10-08 |