| NPI | 1306132600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014022135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-060212) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2022-02-14 |