| NPI | 1821362088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012012827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.128703) |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2024-09-06 |