| NPI | 1023376266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150607) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036138084) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2023-06-26 |