| NPI | 1508988353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: SC 37525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-111266) |
| 207Q00000X Family Medicine (Licence: MI 430-10-72926) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2016-06-13 |