| NPI | 1669457214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 55192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036092014) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2011-01-28 |