| NPI | 1508954736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME158244) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036071703) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-08-03 |