| NPI | 1871692798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019036152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-096023) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-09-26 |