| NPI | 1497979611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01614) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.119584) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-10-25 |