| NPI | 1134641384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.071257) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2023-08-28 |