| NPI | 1154579142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C130733) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-098965) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2022-05-24 |