| NPI | 1942438932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-056300) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2020-11-30 |