| NPI | 1023013638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 36118835) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2003016360) |
| 207Q00000X Family Medicine (Licence: MD D66365) | |
| 207Q00000X Family Medicine (Licence: WI 43269-020) | |
| 207Q00000X Family Medicine (Licence: ND 8219) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2007-07-15 |