| NPI | 1245511476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 14040) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125060712) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2023-09-26 |