| NPI | 1912999277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2004033208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301513156) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2024-10-23 |