| NPI | 1093129835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY C1108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125064448) |
| 207Q00000X Family Medicine (Licence: IL 036141426) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2023-08-30 |