| NPI | 1215992334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 01133) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 27754) |
| 207Q00000X Family Medicine (Licence: IL 03652892) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2011-07-22 |