| NPI | 1689025322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-00223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.069567) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2026-06-03 |