| NPI | 1487678652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200701218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002556A) |
| 207Q00000X Family Medicine (Licence: IL 036104766) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2026-01-28 |