| NPI | 1205152295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A12687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-058844) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2024-03-13 |