| NPI | 1275265423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 348259) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.080898) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2025-09-04 |