| NPI | 1790798981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IL 036074934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C162909) |
| 207Q00000X Family Medicine (Licence: NY 157082) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2024-12-16 |