| NPI | 1376275719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME174635) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125081015) |
| 207Q00000X Family Medicine (Licence: IL 036172592) | |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2025-08-08 |