| NPI | 1487848453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-124679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 14788) |
| 207Q00000X Family Medicine (Licence: WI 71821-20) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2026-01-09 |