| NPI | 1770502940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036094226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 38340020) |
| 207Q00000X Family Medicine (Licence: AK 5348) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |