| NPI | 1164422663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-121749) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 145829) |
| 207Q00000X Family Medicine (Licence: OH 34007910) | |
| 207Q00000X Family Medicine (Licence: MI 5101012318) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2024-01-15 |