| NPI | 1003229402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A143988) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036142833) |
| 207Q00000X Family Medicine (Licence: PA MT206848) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2022-08-01 |