| NPI | 1861752685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018033162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036137199) |
| Enumeration Date | 2012-05-26 |
| Last Update Date | 2018-09-12 |