| NPI | 1922373935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013026727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036170393) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2024-05-31 |