| NPI | 1285896720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-01621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036127335) |
| 207Q00000X Family Medicine (Licence: FL ME108063) | |
| 207Q00000X Family Medicine (Licence: AL 42559) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2022-06-29 |