| NPI | 1497851232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 28215) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-102944) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2015-02-09 |