| NPI | 1841511714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60586394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125058658) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2015-11-25 |