| NPI | 1871600254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD20428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-084531) |
| 207Q00000X Family Medicine (Licence: WI 48511) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2019-03-11 |