| NPI | 1639305972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME123307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036128436) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2019-08-28 |