| NPI | 1699753236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9500705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 84564-20) |
| 207Q00000X Family Medicine (Licence: IL 036171702) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2025-02-26 |