| NPI | 1659752285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 69013-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60849062) |
| 207Q00000X Family Medicine (Licence: IL 125067524) | |
| 207Q00000X Family Medicine (Licence: MN 64415) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2021-12-10 |