| NPI | 1437137957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036139059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 24783) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2016-02-03 |