| NPI | 1326368234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117575) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125058053) |
| 207Q00000X Family Medicine (Licence: IL 036132062) | |
| 208D00000X General Practice (Licence: FL ME117575) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2016-08-18 |