| NPI | 1073004222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-48731) |
| 207Q00000X Family Medicine (Licence: IL 036167181) | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2026-05-08 |