| NPI | 1588923858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63881) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.060787) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2025-03-25 |