| NPI | 1568819845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 71582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.068159) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2021-11-19 |