| NPI | 1144414921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-120622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT186770) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2021-03-03 |