| NPI | 1104171149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036139099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301101459) |
| 208M00000X Hospitalist (Licence: IL 036139099) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2016-12-14 |