| NPI | 1437391356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036084530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 28703) |
| 207Q00000X Family Medicine (Licence: MN 24749) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2009-03-25 |