| NPI | 1982804365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A12578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-049938) |
| 207Q00000X Family Medicine (Licence: MT 11724) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2020-02-20 |