| NPI | 1801044961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A116876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036121911) |
| 207Q00000X Family Medicine (Licence: WI 53145-020) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2013-09-09 |