| NPI | 1750764916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.145304) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2019-11-06 |