| NPI | 1942640875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11505690-1205) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NE 1294) |
| 207Q00000X Family Medicine (Licence: IL 125.063892) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-01-07 |