| NPI | 1720036866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 56093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036067107) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-05-07 |