| NPI | 1447802681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022025511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-075031) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2022-07-22 |