| NPI | 1013932409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-109698) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 89349 (ID#)) |
| 207P00000X Emergency Medicine (Licence: IL 036-109698) | |
| 207Q00000X Family Medicine (Licence: IL 036109698) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-11-14 |