| NPI | 1467567636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 42723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36-097184) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |