| NPI | 1366501140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.122904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 27273) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2021-03-15 |