| NPI | 1770044174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A180365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.073753) |
| 207Q00000X Family Medicine (Licence: IL 125073753) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2022-09-14 |