| NPI | 1114450988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64086) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036153680) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2024-02-12 |