| NPI | 1669866737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 33745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.067309) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-03-12 |