| NPI | 1861680431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 14748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125050193) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2020-09-30 |