| NPI | 1821438268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MMD.40028 MD) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-139024) |
| 207Q00000X Family Medicine (Licence: LA 307433) | |
| Enumeration Date | 2013-06-30 |
| Last Update Date | 2020-07-23 |