| NPI | 1265111579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351051693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.085009) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2024-07-04 |