| NPI | 1174834931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.161221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A125375) |
| Enumeration Date | 2010-06-27 |
| Last Update Date | 2022-08-11 |