| NPI | 1003072687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 56001-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.054488) |
| 207Q00000X Family Medicine (Licence: IL 036.126371) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2025-11-06 |