| NPI | 1992803985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-00509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-103802) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-04-04 |