| NPI | 1801393913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020016504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.072843) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2021-07-27 |