| NPI | 1942221494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 92032) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088640) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2024-08-23 |