| NPI | 1295115913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 336107600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 32439) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-08-11 |