| NPI | 1518356609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY C0745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0094339) |
| 207Q00000X Family Medicine (Licence: IL 036160620) | |
| 207Q00000X Family Medicine (Licence: DE C2-0024053) | |
| 207Q00000X Family Medicine (Licence: HI DOS-1911) | |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2026-05-18 |