| NPI | 1144515610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.059709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 8570024-1204) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2017-03-13 |