| NPI | 1124551809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 56913) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.075298) |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2023-09-15 |