| NPI | 1710029582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036113686) |
| 207Q00000X Family Medicine (Licence: IN 02002897A) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-09-18 |