| NPI | 1558359448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 47422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-105232) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2011-06-23 |