| NPI | 1427286038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036144530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 45065) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2018-05-10 |