| NPI | 1467618249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A122992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.129067) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2014-04-04 |