| NPI | 1831109347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2000146084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036101781) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2025-02-07 |