| NPI | 1932187416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-04159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036106892) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2021-06-14 |