| NPI | 1821064213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME135865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036104384) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2022-12-08 |