| NPI | 1952626798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 57416-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101020565) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2020-11-13 |