| NPI | 1629045778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036086946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 33781) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2015-08-04 |