| NPI | 1396720694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036058406) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2024-06-04 |