| NPI | 1205458650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 58196) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125075684) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2023-12-06 |