| NPI | 1083806384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036118811) |
| 207Q00000X Family Medicine (Licence: IN 01064330A) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2023-10-16 |