| NPI | 1285251892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A186106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.077200) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2023-10-19 |