| NPI | 1134416720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018012741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125069720) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2018-10-23 |