| NPI | 1861873804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60897378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-066862) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2021-03-19 |