| NPI | 1881746659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 18879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301083635) |
| 207Q00000X Family Medicine (Licence: MD D0059389) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-07-12 |