| NPI | 1699987230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.126441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60050999) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2024-08-26 |