| NPI | 1215946892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60513668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036116544) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-04-04 |