| NPI | 1598029704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2015-01625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2015-01625) |
| 207Q00000X Family Medicine (Licence: WI 84941) | |
| 207Q00000X Family Medicine (Licence: MI 4301100843) | |
| 207Q00000X Family Medicine (Licence: IL 036.174129) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2025-04-18 |