| NPI | 1861021636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023034908) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036171512) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-09-11 |