| NPI | 1073023594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A174462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125071582) |
| 207Q00000X Family Medicine (Licence: IL 036.157093) | |
| 207Q00000X Family Medicine (Licence: WI 74854-20) | |
| 207Q00000X Family Medicine (Licence: AZ 63792) | |
| 207Q00000X Family Medicine (Licence: AL 45836) | |
| 208600000X Surgery (Licence: IL 125071582) | |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2023-05-04 |