| NPI | 1508206749 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 60252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125063374) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2016-09-20 |