| NPI | 1063455582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-101089) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2021-04-07 |