| NPI | 1619397197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 077517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 72087) |
| 207Q00000X Family Medicine (Licence: WI 18378) | |
| 207Q00000X Family Medicine (Licence: IL 036167273) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2024-08-28 |