| NPI | 1457445298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 37650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-092677) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-12-28 |