| NPI | 1548827124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 65909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.073528) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2022-07-25 |