| NPI | 1871889816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME133184) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036133933) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2023-04-18 |