| NPI | 1508064932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 38201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8205) |
| 207Q00000X Family Medicine (Licence: IL 036135436) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2025-02-18 |