| NPI | 1720243777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q3581) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125054699) |
| 207Q00000X Family Medicine (Licence: IL 036.126251) | |
| 207Q00000X Family Medicine (Licence: IL 336.087840) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA09009500) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2016-01-26 |