| NPI | 1033788484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME170290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125079020) |
| 207Q00000X Family Medicine (Licence: IL 125-079020) | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2024-08-27 |