| NPI | 1245590496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-00058) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-172680) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2024-12-03 |