| NPI | 1831350578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 66459) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-055120) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2023-08-29 |