| NPI | 1164756920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.131133) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27283) |
| 207Q00000X Family Medicine (Licence: IA 40224) | |
| 207QB0002X Family Medicine Obesity Medicine (Licence: IL 036.131133) | |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2022-12-22 |