| NPI | 1770929010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.062783) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2020-06-26 |