| NPI | 1760707608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0052360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.131305) |
| Enumeration Date | 2010-04-04 |
| Last Update Date | 2022-02-04 |