| NPI | 1124072400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101015506) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036113084) |
| 207Q00000X Family Medicine (Licence: PA OS025203C) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2025-07-16 |