| NPI | 1437167277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-105459) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44662-020) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2011-10-19 |