| NPI | 1578880068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.133472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54132) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2021-03-02 |