| NPI | 1578940664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME135933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.144296) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2022-01-06 |