| NPI | 1922485515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101025584) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MI 5101025584) |
| 261QU0200X Clinic/Center, Urgent Care (Licence: MI 5101025584) | |
| Enumeration Date | 2015-05-03 |
| Last Update Date | 2022-03-22 |