| NPI | 1376749002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-069558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 27665) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2007-07-08 |