| NPI | 1124641907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A187356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125076078) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2023-08-31 |