| NPI | 1750692208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125057476) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2024-06-14 |