| NPI | 1740535608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A139100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-06420) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2020-05-29 |