| NPI | 1174628374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64875-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-100708) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-01-16 |