| NPI | 1326171729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-116612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102202377) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-07-29 |