| NPI | 1962060699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.148464) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301507389) |
| 208D00000X General Practice (Licence: OH 35.148464) | |
| 208D00000X General Practice (Licence: MI 4301507389) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.148464) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2024-09-13 |