| NPI | 1720406549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A145634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125065903) |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2019-12-26 |