| NPI | 1659397701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60126114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36057332) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2010-03-22 |