| NPI | 1154636777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1014651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125057536) |
| 207Q00000X Family Medicine (Licence: FL ME121037) | |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2024-03-01 |