| NPI | 1376237453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.082298) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 62317) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2026-07-27 |