| NPI | 1548251705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD49339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-120253) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2022-03-23 |