| NPI | 1205064219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 32263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036122107) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2022-03-07 |