| NPI | 1821435983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015020737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.062658) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2021-08-05 |