| NPI | 1790275923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 33815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.155540) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2024-01-31 |