| NPI | 1891992608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010008639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125053717) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2020-10-21 |