| NPI | 1396301040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023017492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11458) |
| 207Q00000X Family Medicine (Licence: IL 036161447) | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2023-08-24 |