| NPI | 1417977125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-079869) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-10-25 |