| NPI | 1326300831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.061309) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2024-08-05 |