| NPI | 1497779755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 025349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036109963) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-01-07 |