| NPI | 1518075282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 46420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36100747) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2017-10-18 |