| NPI | 1184251266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036163059) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: IL 036.163059) |
| 207Q00000X Family Medicine (Licence: CA A191066) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-04-22 |