| NPI | 1619237856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60994911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.136571) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2021-03-18 |