| NPI | 1962864199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.150366) |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2023-09-15 |