| NPI | 1134672298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60945077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125069427) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2020-12-03 |