| NPI | 1144668948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020017666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.063612) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2020-07-13 |