| NPI | 1922040278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: VA 0101241399) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-098581) |
| 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101241399) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-11-27 |