| NPI | 1427149764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 36554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-068950) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |