| NPI | 1861620981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125-052067) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 40788) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2023-04-05 |