| NPI | 1568474831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 48333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.103688) |
| 207Q00000X Family Medicine (Licence: NY 223530-1) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2010-10-26 |