| NPI | 1770550782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 49469) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-098344) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2022-04-05 |