| NPI | 1518002948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301035155) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-056652) |
| 208D00000X General Practice (Licence: AL 44281) | |
| 208D00000X General Practice (Licence: AK 189273) | |
| 208D00000X General Practice (Licence: AR E-15241) | |
| 208D00000X General Practice (Licence: AR 66947) | |
| 208D00000X General Practice (Licence: AZ 66947) | |
| 208D00000X General Practice (Licence: CA G33486) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2022-06-06 |