| NPI | 1184911695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017015252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036133714) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2021-11-16 |