| NPI | 1699295758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A166992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.071042) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2023-02-03 |