| NPI | 1033630124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD048736) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.070326) |
| 207Q00000X Family Medicine (Licence: MD D0089405) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2021-01-19 |