| NPI | 1366542763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 195031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036060973) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-11-20 |