| NPI | 1013180090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME136311) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.120369) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2019-12-16 |