| NPI | 1821650730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A176629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-074077) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2024-04-05 |