| NPI | 1558339150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 41583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008034638) |
| 207Q00000X Family Medicine (Licence: IL 036119085) | |
| 207Q00000X Family Medicine (Licence: WI 48713) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-10-02 |