| NPI | 1578526224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64469) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-096892) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2016-01-04 |