| NPI | 1285742072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 22941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-065951) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-09-30 |