| NPI | 1922373935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013026727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036170393) |
| 207Q00000X Family Medicine (Licence: PA OS024398) | |
| 207Q00000X Family Medicine (Licence: SC 92616) | |
| 207Q00000X Family Medicine (Licence: FL OS21515) | |
| 207Q00000X Family Medicine (Licence: AZ 011275) | |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2024-12-05 |