| NPI | 1922235944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 67221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036129133) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2022-01-13 |