| NPI | 1497763783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2003023209) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-113309) |
| 207Q00000X Family Medicine (Licence: IL 036-113309) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2015-02-19 |