| NPI | 1043258650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2008018535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36115421) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2021-11-12 |