| NPI | 1649240888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036138331) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 38606) |
| 207Q00000X Family Medicine (Licence: WI 51131-020) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-04-12 |