| NPI | 1023324696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 76214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.132500) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2026-03-22 |