| NPI | 1639304355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-00743) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036123466) |
| 208D00000X General Practice (Licence: NC 2016-00743) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2024-02-21 |