| NPI | 1235111022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A87529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 336070497) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2021-12-21 |