| NPI | 1346561883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME165872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.140928) |
| 207Q00000X Family Medicine (Licence: CA C174034) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2025-06-23 |