| NPI | 1750737367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 71165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-068084) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2023-12-27 |