| NPI | 1295779353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AL 11090) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 36296) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036129102) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2026-03-03 |