| NPI | 1699272237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036172016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301505421) |
| 207Q00000X Family Medicine (Licence: IA 52631) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2024-09-24 |