| NPI | 1427285071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-40314) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IA MD-40314) |
| 207Q00000X Family Medicine (Licence: IL 125-056824) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2022-08-29 |