| NPI | 1477780849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 29336) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-056766) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2022-02-23 |