| NPI | 1568758688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 27546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-060368) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2020-05-29 |