| NPI | 1023512001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102207049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036155049) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2022-07-19 |