| NPI | 1710913116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME85068) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-100925) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2016-11-21 |