| NPI | 1255403663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME145449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-101053) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-07-06 |