| NPI | 1154674877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 144514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125060127) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2018-05-08 |