| NPI | 1407296999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 49417) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP168) |
| 207Q00000X Family Medicine (Licence: IL 125.062765) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-08-20 |