| NPI | 1346269586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301069296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 39564) |
| 207Q00000X Family Medicine (Licence: IL 036069689) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-07-22 |