| NPI | 1538110960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-108107) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 45217) |
| 207Q00000X Family Medicine (Licence: IA 34949) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2017-01-09 |