| NPI | 1235236241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036109034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 3922) |
| 207Q00000X Family Medicine (Licence: TX J5734) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-02-17 |