| NPI | 1295826675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036115033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2009-00236) |
| 207Q00000X Family Medicine (Licence: MO 2009038317) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-08-27 |