| NPI | 1265878193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-44888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A137583) |
| 207Q00000X Family Medicine (Licence: IL 036143520) | |
| Enumeration Date | 2013-05-19 |
| Last Update Date | 2024-03-14 |