| NPI | 1649764812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 69945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125071964) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-08-10 |