| NPI | 1417995887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 45654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036071095) |
| 207QA0000X Family Medicine Adolescent Medicine (Licence: IL 036071095) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-03-07 |