| NPI | 1982860276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60205330) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125055391) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2022-12-19 |