| NPI | 1518020353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A20836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036132077) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2023-06-12 |