| NPI | 1417211624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125061882) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2017-01-18 |