| NPI | 1760041925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.074824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-02424) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2025-11-11 |