| NPI | 1992226831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61088060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125071478) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2022-07-21 |