| NPI | 1609010727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.169221) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2025-11-04 |