| NPI | 1598902728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009030106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036122359) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2009-10-27 |