| NPI | 1235171463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036150921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 46382) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-10-02 |