| NPI | 1144845884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2023-0578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125076778) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2023-07-03 |