| NPI | 1750729240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME126754) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-063430) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2017-09-20 |