| NPI | 1184966509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WI 62791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 62791-20) |
| 207Q00000X Family Medicine (Licence: IL 036.139342) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: IL 036139342) | |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2022-10-25 |