| NPI | 1003044421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-056918) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2025-06-26 |