| NPI | 1396725768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 02836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-102383) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2014-01-15 |