| NPI | 1720160179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C169363) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036115460) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2022-03-07 |