| NPI | 1316398506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036160448) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10727) |
| 207Q00000X Family Medicine (Licence: NH 19489) | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-12-02 |