| NPI | 1134582521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.153454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 52789) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2021-03-30 |