| NPI | 1568471274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036112014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 38680) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-12-16 |