| NPI | 1477597342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036114984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 241377) |
| 207Q00000X Family Medicine (Licence: GA 63412) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2014-10-02 |