| NPI | 1043552862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60660929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036138919) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2019-07-10 |