| NPI | 1720098429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G58183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.176979) |
| 207Q00000X Family Medicine (Licence: HI MD-13166) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2025-10-29 |