| NPI | 1740740059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2024034688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-49609) |
| 207Q00000X Family Medicine (Licence: IL 036169694) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2024-10-23 |