| NPI | 1336450360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036074355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02001948A) |
| 207Q00000X Family Medicine (Licence: CA 20A8254) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2010-06-24 |