| NPI | 1053765487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0098041) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018020870) |
| 207Q00000X Family Medicine (Licence: IL 125069142) | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2023-09-26 |