| NPI | 1093091423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-01464) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-134290) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2022-09-01 |