| NPI | 1942317276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME100168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 43889) |
| 207Q00000X Family Medicine (Licence: IL 036100830) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2023-04-19 |