| NPI | 1184894859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 076590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101245670) |
| 207Q00000X Family Medicine (Licence: IL 036.119478) | |
| Enumeration Date | 2008-03-09 |
| Last Update Date | 2022-01-10 |