| NPI | 1003826918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117071) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036061047) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2018-10-31 |