| NPI | 1306133673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 62539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.060636) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2023-11-14 |