| NPI | 1063932002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020019624) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125071326) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2024-05-01 |