| NPI | 1750965653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61690063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.171318) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2025-09-24 |