| NPI | 1225080666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 33241) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-088251) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2013-03-15 |