| NPI | 1831579598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.067375) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2022-03-14 |