| NPI | 1518958651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 57636) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036105695) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2019-12-12 |