| NPI | 1114019049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO T2006017510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036123174) |
| 207Q00000X Family Medicine (Licence: WA MD61380771) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-02-12 |