| NPI | 1902899792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-084853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 33453020) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2021-12-10 |