| NPI | 1295186633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-03322) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-171384) |
| 207Q00000X Family Medicine (Licence: WI 81622) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2024-12-17 |