| NPI | 1093744617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 50353-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-108395) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-10-20 |