| NPI | 1154859239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019016548) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-070793) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2022-07-21 |