| NPI | 1649228990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME164802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036085055) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-02-08 |