| NPI | 1558511519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125060808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 37762) |
| 207Q00000X Family Medicine (Licence: SC 37762) | |
| 207P00000X Emergency Medicine (Licence: RI LP01289) | |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2021-11-16 |