| NPI | 1932384955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 2022-00800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036131956) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2022-09-01 |