| NPI | 1568783413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 61030-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125057627) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2013-08-02 |