| NPI | 1780082693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206019) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-144866) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2024-05-14 |