| NPI | 1407167356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82602-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC101072) |
| 207Q00000X Family Medicine (Licence: IL 036138349) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-07-03 |