| NPI | 1801580428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME176487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.082464) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2026-07-17 |