| NPI | 1477286714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125080367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2026-03125) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2026-07-14 |