| NPI | 1770841678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036142979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 61487) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2021-04-19 |