| NPI | 1619237849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04733) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-061858) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2025-09-12 |